One of the first things that makes the Cleveland Food Retail Systemunique is that it is informed through primary data collection.

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2 One of the first things that makes the Cleveland Food Retail Systemunique is that it is informed through primary data collection. We use a two part definition: First, It is a systematic effort to document all locations within the City of Cleveland that sell food in a retail environment meant for individual purchase. So this includes grocery stores, corner stores, gas stations, butchers, bakeries, and other specialty shops. Second, we conduct an in-store audit to assess the presence of specific items available for purchase, such as fresh produce, fresh raw meat, milk, alcohol, tobacco, chips, candy, and soda. 2

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4 I m going to show you aseries of maps of what we refer to as grocery stores with a rather liberal definition based on the presence of at least 3 types of fruits, at least 3 types of vegetables, low fat milk, and fresh raw meat. 4

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7 So we went from 39 in 2012, to 40 in 2013, to 51 in 2014, to 67 in 2015, but note that much of the jump in 2015 is due to the addition of the Downtown area. Some of you may be looking at this map and thinking this doesn t look so bad, but let me remind you of the definition that we used for grocery store: 3 fruits, 3 vegetables, low fat milk, raw meat. Also, this map merely denotes stores that carry these items and does not provide information on other characteristics of the stores, including shopper perceptions of cleanliness, safety, or the freshness and quality of the food. Further, if we applied criteria related to store size (assess by the number of cash registerstas a proxy), the number of stores would decrease. 7

8 Returning back to our map of grocery stores, we see significant blocks of the city that have very high rates of SNAP utilization with access to very few stores. But they aren t altogether without access to food. 8

9 In fact, in these very same regions there exist several small groceries, corner stores, convenience stores, and gas stations, and these stores are beginning to see the opportunity they have to better serve the community and fill the perishable and healthy food gap to improve food access. Todate, we have engaged with 15 stores who have added produce and other healthy items into their stores to increase access in their neighborhoods. We expect that our 2016 and 2017 maps will look substantially different in these circled areas due to the concerted efforts of partners of the Health Improvement Partnership of Cuyahoga County. Similar work has already been carried out by the Tremont West Development Corporation s Tremont Healthy CornerstoreProject, where four stores previously classified as corner stores based on food offering have now been classified as grocery stores. 9

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11 (Slideis animated). The am working on total no. of stores to date. Should have a figure by tomorrow. Table 2 is no. of stores in each phase. 11

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13 Wepiloted Nutrition Education sessions at Hayden this summer in partnership with OSU-E and Stephanie Tubbs Jones. It included 4, once a week nutrition session. Each week was a different topic area: whole grains, low fat, proteins and fruits/veggies. Free health screening and counselling services were offered 2 times. 13

14 So we went from 39 in 2012, to 40 in 2013, to 51 in 2014, to 67 in 2015, but note that much of the jump in 2015 is due to the addition of the Downtown area. Some of you may be looking at this map and thinking this doesn t look so bad, but let me remind you of the definition that we used for grocery store: 3 fruits, 3 vegetables, low fat milk, raw meat. Also, this map merely denotes stores that carry these items and does not provide information on other characteristics of the stores, including shopper perceptions of cleanliness, safety, or the freshness and quality of the food. Further, if we applied criteria related to store size (assess by the number of cash registerstas a proxy), the number of stores would decrease. 14

15 With the hardwork of the Cleveland Cuyahoga County Food Policy Coalition and our friends at the Ohio State University Extension, we saw substantial growth in farmers markets, shown here as the blue plus-signs on the map. You will notice how many of these markets are located in areas that do not have a grocery store within the census tract, or even close by, and this was an attempt to begin to close the gap on healthy food access in Cleveland. 15

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17 Thisslide presents a picture of the overall implementation for 2015 which basically included 2 arms, one working at the FM level where MM were trained on maintaining voucher redemption logs for PRxAND..atthe clinic level, where 7 providers were identified to lead the program. Providers at the clinic received assistance in: 17

18 Peak farmers market season in Cuyahogacounty is from July to October with some markets that offer year round produce. 18

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22 Sign rank data 22

23 For full sample (n=224), per redemption log data: A total of 189 participants (84%) visited a FM at least once Average number of visits was 2 (range 0-6) Average number of $10 vouchers redeemed was 6 (range 0-12) Over $14,000 worth of produce vouchers redeemed (and counting; current data is through Dec) -In the map, blue dots are the20 FM that participated, red cross are the hospitals, while a purple dot within blue dots are the Markets that were patronized by our PRxparticipants 23

24 From visit 2, check-insurvey we compiled patients responses to what they bought at the markets In this word cloud, words are sized by frequency of report. Most popular items bought were routine items such as apples, tomatoes, squash, peaches, greens, onions, peppers, potatoes 24

25 Significant improvement in FV consumption (using the validated 7-item FV Food Behavior Checklist (Townsend)) was observed (mean score at baseline=15.5, mean score at followup=19.1; p<0.001). (All items score 0-4 points, Max possible score is 28, Serving=~1/2 cup) MyplateAverageadult daily recommendation Fruits: 2 Cups daily for 2000 caldaily Veg: 2.5 Cups daily 25

26 Among pts with follow-up (post survey, n=140) 26

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